Discrepancies between medication orders and infusion pump programming in a paediatric intensive care unit

• Published in: Quality & safety in health care Vol. 19; no. Suppl 3; pp. i31 - i35
• Main Authors: Russell, Rebecca A, Murkowski, Kathy, Scanlon, Matthew C
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.10.2010; BMJ Publishing Group LTD
• Subjects: Adolescent; Child; Child, Preschool; Children & youth; computer order entry; Critical Illness - therapy; Data collection; Designers; Drug dosages; Equipment Safety; Female; Health administration; healthcare quality improvement; human factors; Humans; Infant; Infant, Newborn; Infusion Pumps; Infusions, Intravenous; Intensive care; Intensive Care Units, Pediatric; Medical errors; Medical Order Entry Systems; Medical Staff, Hospital - standards; medication error; Medication Errors - classification; Medication Errors - prevention & control; Medication Reconciliation - standards; medication safety; Medications; Metabolic disorders; Nurses; Nursing; Order entry; patient safety; Patients; pediatrics; Physicians; Prospective Studies; Qualitative Research; risk; Risk Assessment; Studies; United States; Workloads; United States
• ISSN: 1475-3898; 1475-3901
• DOI: 10.1136/qshc.2009.036384

BackgroundErrors and the incorrect use of medications are significant sources of risk and harm to children in US hospitals. The risk associated with medication infusions has led to recommendations for the adoption of technologies including computer order physician entry (CPOE) and ‘smart’ infusion pumps despite a paucity of evidence demonstrating the ability of these technologies to reduce harm to paediatric inpatients.ObjectiveTo measure discrepancies between medication orders for infusions entered into a CPOE system and the medication being infused as measured by the programmed settings of the smart infusion pump within a paediatric intensive care unit.MethodsThis study used a prospective, observational design in a 30-bed paediatric intensive care unit. Data were simultaneously collected from the medication orders in the CPOE system and the bedside smart infusion pumps by trained observers. Analysis consisted of a line-by-line comparison of order observation data with the pump observation data.ConclusionsOf 296 observations of medication infusions and 231 observations of intravenous fluid infusions, the frequency of discrepancies between orders entered and pumps programming ranged from 24.3% for observed medications to 42.4% for observed fluids. Anti-infectives (100%), concentrated electrolytes (46.7%) and anticoagulants (46.2%) were associated with greatest discrepancy between orders and programmed doses.